Macrolide resistance in Mycoplasma pneumoniae in adult patients
Mycoplasma pneumoniae is one of the most significant pathogens responsible for respiratory infections in humans. Macrolides are recommended as the first-line treatment for M. pneumoniae infection. The prevalence of macrolide-resistant M. pneumoniae has increased significantly in recent decades, part...
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Frontiers Media S.A.
2025-03-01
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| Series: | Frontiers in Cellular and Infection Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcimb.2025.1496521/full |
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| author | Panpan Xie Panpan Xie Yue Zhang Yue Zhang Yanhong Qin Yanhong Qin Yun Fang Yun Fang Ning Yang Ning Yang Yunbiao Bai Yunbiao Bai Shimeng Zhi Shimeng Zhi Wenkai Niu Wenkai Niu Fusheng Wang Xin Yuan Xin Yuan Xin Yuan |
| author_facet | Panpan Xie Panpan Xie Yue Zhang Yue Zhang Yanhong Qin Yanhong Qin Yun Fang Yun Fang Ning Yang Ning Yang Yunbiao Bai Yunbiao Bai Shimeng Zhi Shimeng Zhi Wenkai Niu Wenkai Niu Fusheng Wang Xin Yuan Xin Yuan Xin Yuan |
| author_sort | Panpan Xie |
| collection | DOAJ |
| description | Mycoplasma pneumoniae is one of the most significant pathogens responsible for
respiratory infections in humans. Macrolides are recommended as the first-line treatment for M. pneumoniae infection. The prevalence of macrolide-resistant M. pneumoniae has increased significantly in recent decades, particularly in China. The mechanisms of resistance in M. pneumoniae to macrolides have been extensively studied in pediatric patients. However, a paucity reports regarding the resistance characteristics and mechanisms exhibited in adults. The aim of this study was to elucidate the resistance of M. pneumoniae to macrolides and the underlying mechanisms in adult patients. Pharyngeal swab specimens were collected from adult patients presenting with subacute cough or community-acquired pneumonia at our hospital from January 2011 to June 2017 to identify and isolate M. pneumoniae strains. The antimicrobial susceptibility of these isolates to 3 macrolide antibiotics was assessed using broth microdilution method. The 23S rRNA genes of macrolide-resistant M. pneumoniae strains were sequenced, and the presence of target methylation genes (ermA, ermB, and ermC), efflux pump genes (mefA, mefA/E, msrA, and msrA/B), and the macrolide resistance gene mphC was identified through polymerase chain reaction (PCR) testing. Additionally, MICs were determined with and without the efflux pump inhibitor reserpine. A total of 72 M. pneumoniae strains were isolated from adult patients, with 41.7% (30/72) exhibiting macrolide resistance. Among the 3 macrolides tested, the 16-membered-ring midecamycin exhibited the greatest activity (MIC90: 16 µg/ml) against M. pneumoniae. All macrolide-resistant M. pneumoniae strains harbored mutations at the 2063 site in domain V of the 23S rRNA gene. Two macrolide-resistant M. pneumoniae clinical isolates were found to harbor the efflux pump genes msrA/B and mefA. The efflux pump inhibitor reserpine reduced the MIC for azithromycin in these two strains to a quarter of their original values. In summary, macrolide-resistant M. pneumoniae is commonly observed among adults in Beijing. Point mutations are the primary mechanism responsible for macrolide resistance in adults with M. pneumoniae. Additionally, the efflux pump mechanism may contribute partially to this resistance. Midecamycin presents a promising alternative drug for treating M. pneumoniae infections, particularly in cases of azithromycin-resistant M. pneumoniae infection in young children. |
| format | Article |
| id | doaj-art-0c74374b1fa542ada47ef4485678e7d3 |
| institution | DOAJ |
| issn | 2235-2988 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj-art-0c74374b1fa542ada47ef4485678e7d32025-08-20T03:02:22ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882025-03-011510.3389/fcimb.2025.14965211496521Macrolide resistance in Mycoplasma pneumoniae in adult patientsPanpan Xie0Panpan Xie1Yue Zhang2Yue Zhang3Yanhong Qin4Yanhong Qin5Yun Fang6Yun Fang7Ning Yang8Ning Yang9Yunbiao Bai10Yunbiao Bai11Shimeng Zhi12Shimeng Zhi13Wenkai Niu14Wenkai Niu15Fusheng Wang16Xin Yuan17Xin Yuan18Xin Yuan19Department of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaThe Fifth Clinical Medical College, Anhui Medical University, Hefei, Anhui, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, ChinaThe Fifth Clinical Medical College, Anhui Medical University, Hefei, Anhui, ChinaSenior Department of Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, ChinaMycoplasma pneumoniae is one of the most significant pathogens responsible for respiratory infections in humans. Macrolides are recommended as the first-line treatment for M. pneumoniae infection. The prevalence of macrolide-resistant M. pneumoniae has increased significantly in recent decades, particularly in China. The mechanisms of resistance in M. pneumoniae to macrolides have been extensively studied in pediatric patients. However, a paucity reports regarding the resistance characteristics and mechanisms exhibited in adults. The aim of this study was to elucidate the resistance of M. pneumoniae to macrolides and the underlying mechanisms in adult patients. Pharyngeal swab specimens were collected from adult patients presenting with subacute cough or community-acquired pneumonia at our hospital from January 2011 to June 2017 to identify and isolate M. pneumoniae strains. The antimicrobial susceptibility of these isolates to 3 macrolide antibiotics was assessed using broth microdilution method. The 23S rRNA genes of macrolide-resistant M. pneumoniae strains were sequenced, and the presence of target methylation genes (ermA, ermB, and ermC), efflux pump genes (mefA, mefA/E, msrA, and msrA/B), and the macrolide resistance gene mphC was identified through polymerase chain reaction (PCR) testing. Additionally, MICs were determined with and without the efflux pump inhibitor reserpine. A total of 72 M. pneumoniae strains were isolated from adult patients, with 41.7% (30/72) exhibiting macrolide resistance. Among the 3 macrolides tested, the 16-membered-ring midecamycin exhibited the greatest activity (MIC90: 16 µg/ml) against M. pneumoniae. All macrolide-resistant M. pneumoniae strains harbored mutations at the 2063 site in domain V of the 23S rRNA gene. Two macrolide-resistant M. pneumoniae clinical isolates were found to harbor the efflux pump genes msrA/B and mefA. The efflux pump inhibitor reserpine reduced the MIC for azithromycin in these two strains to a quarter of their original values. In summary, macrolide-resistant M. pneumoniae is commonly observed among adults in Beijing. Point mutations are the primary mechanism responsible for macrolide resistance in adults with M. pneumoniae. Additionally, the efflux pump mechanism may contribute partially to this resistance. Midecamycin presents a promising alternative drug for treating M. pneumoniae infections, particularly in cases of azithromycin-resistant M. pneumoniae infection in young children.https://www.frontiersin.org/articles/10.3389/fcimb.2025.1496521/fullMycoplasma pneumoniaemacrolide resistanceresistant mechanismpoint mutationsefflux pump |
| spellingShingle | Panpan Xie Panpan Xie Yue Zhang Yue Zhang Yanhong Qin Yanhong Qin Yun Fang Yun Fang Ning Yang Ning Yang Yunbiao Bai Yunbiao Bai Shimeng Zhi Shimeng Zhi Wenkai Niu Wenkai Niu Fusheng Wang Xin Yuan Xin Yuan Xin Yuan Macrolide resistance in Mycoplasma pneumoniae in adult patients Frontiers in Cellular and Infection Microbiology Mycoplasma pneumoniae macrolide resistance resistant mechanism point mutations efflux pump |
| title | Macrolide resistance in Mycoplasma pneumoniae in adult patients |
| title_full | Macrolide resistance in Mycoplasma pneumoniae in adult patients |
| title_fullStr | Macrolide resistance in Mycoplasma pneumoniae in adult patients |
| title_full_unstemmed | Macrolide resistance in Mycoplasma pneumoniae in adult patients |
| title_short | Macrolide resistance in Mycoplasma pneumoniae in adult patients |
| title_sort | macrolide resistance in mycoplasma pneumoniae in adult patients |
| topic | Mycoplasma pneumoniae macrolide resistance resistant mechanism point mutations efflux pump |
| url | https://www.frontiersin.org/articles/10.3389/fcimb.2025.1496521/full |
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